Dating of endometrium
SEE VIDEO BY TOPIC: Histopathology Endometrium--Endometrial polypContent:
- Endometrial dating in the conception cycle.
- Secretory phase endometrium
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- Dating of the endometrium by microhysteroscopy.
- Dating the endometrial biopsy.
- How precise is histologic dating of endometrium using the standard dating criteria?
- Normal Endometrium and Infertility Evaluation
- Hormonal Pathology of the Endometrium
Endometrial dating in the conception cycle.
A total of patients who underwent hysteroscopic assessment of the endometrium and then became pregnant, was analysed retrospectively to explore the relationship between endoscopic findings and early phase pregnancy outcome after implantation. Histological examination of the endometrium and assay of serum progesterone and oestrogen were carried out simultaneously with hysteroscopy.
Of patients, 12 were excluded. Of the remaining patients, 62 Of pregnancies, persisted successfully to live birth, but 42 ended in early pregnancy loss. In conclusion, our data suggest that the hysteroscopic appearance of the mid-secretory endometrium at this stage of the menstrual cycle is a better prognostic factor for pregnancy outcome than hormonal data.
The endometrium of the secretory phase is morphologically and functionally well-prepared for implantation and the early development of the fertilized ovum. The maturation process of the endometrium is mediated by ovarian sex steroid hormones. In clinical practice, morphological information on endometrial maturation is available from histological evaluation and ultrasound assessment.
Hysteroscopy is not yet used routinely to observe the morphological condition of the endometrium, although it has been employed in studying endometrial pathologies which might cause female infertility De Jong et al.
Previous studies have shown that hysteroscopic observations could provide useful morphological information to evaluate the functional state of the endometrium, based on serial phase-specific changes in appearance of glandular openings and vasculature on the endometrial surface in subjects with normal ovulatory cycles Inafuku, ; Sakumoto et al.
In this context, it was felt to be of interest whether or not the hysteroscopic appearance of the endometrium is associated with early pregnancy loss as well as with implantation failure of fertilized ovum. The aims of the present study using hysteroscopic assessment of the mid-secretory phase endometrium were: i to explore whether or not there is a relationship between hysteroscopic findings and early phase pregnancy outcome after implantation; and ii to compare endoscopic findings with histological and endocrinological backgrounds.
All patients who had undergone hysteroscopic examination of the endometrium at our University Hospital, Okinawa, Japan, between January and December , and became pregnant, were considered for the study. Patients with chemical or subclinical abortion, i.
The vast majority of patients underwent outpatient hysteroscopy as part of the overall evaluation of infertility or repeated early abortion. At diagnosis of pregnancy, the mean age of the patients was These pregnant patients were analysed retrospectively with special reference to a possible relationship between endoscopic findings and pregnancy outcome.
Nine patients, whose pregnancies ended in ectopic pregnancy or in miscarriage suspected to be due to significant factors, e. Three patients were lost to follow-up after conception. Thus, women were included in this analysis. Hysteroscopy was scheduled in a menstrual cycle not manipulated with any hormonal agents. Patients were well informed regarding the procedure and were asked to prevent conception in the cycle.
Lidocaine is not thought to have vaso-constrictive or dilative effects. No apparent change was observed in vasculature between pre- and post-PCB in those patients receiving PCB in the middle of hysteroscopy. Patients received cleansing and disinfection of their vulva and vagina in the dorsal lithotomy position. A rigid hysteroscope which had a 4.
After introducing the hysteroscope through the internal uterine os, the uterine cavity was scanned thoroughly. After completion of the examination, endometrial biopsy was performed in 32 patients who agreed to the procedure.
Hysteroscopic findings were observed and diagnosed by more than three gynaecologists, including the authors H. The specimens biopsied in 32 patients were submitted to conventional light microscopic examination to compare the observed hysteroscopic findings with histology of the endometrium.
Post-ovulatory day of the cycle was specified by one of the authors K. Serum progesterone and oestradiol, taken on the day of hysteroscopy, were measured in 83 patients by enzyme immunoassay kits DPC Estradiol and Progesterone assay kits; Diagnostic Products Corporation.
CA, USA. The normal values for progesterone and oestradiol in the luteal phase days 3—15 after ovulation were 0. In this study, early pregnancy loss early spontaneous abortion was categorized into blighted ovum or intrauterine embryonic death, based on the findings of serial transvaginal ultrasonography.
Blighted ovum was designated in cases where embryonic echoes were never visualized in the gestational sac, and embryonic death in cases where embryo heart action, which had been once identified, disappeared within 11 weeks of gestation menstrual age. Of patients, 62 The clinical characteristics of these two groups are shown in Table I. There were no differences either in the frequency of patients with infertility factors or the distribution pattern of infertility factors between the two groups, and the overwhelming majority of patients had infertility factors.
As shown in Table II , of the pregnancies occurring after hysteroscopic examination, 68 It was noted that 32 of these 68 pregnancies occurred in patients who had undergone hysterosalpingography or selective salpingography alone, several months prior to conception. There were no significant differences between the two groups for any of these assisted interventions. Of the pregnancies, persisted successfully to live birth term and 16 preterm , but 42 ended in early pregnancy loss 20 in embryo deaths and 22 in blighted ova Table II.
No patients were encountered who suffered from late abortion at 12—21 weeks gestation. Endometrial specimens from 32 patients were examined to specify the post-ovulatory day of the cycle according to histological criteria for dating the endometrium Table III. Serum samples from 83 patients were submitted to progesterone and oestradiol assays Table IV. In , the hysteroscopic appearance of the secretory endometrium was described Sakumoto et al.
It was also documented in our unpublished pilot study that there were no significant variations within individuals during at least five or six different menstrual cycles in the classification of their endometrial appearance. However, these hysteroscopic data were not compared with the histological and endocrinological backgrounds. First, of the patients studied, 98 This was close to the This suggests that unfavourable hysteroscopic findings are associated with early pregnancy loss after implantation.
Thirdly, there were no significant differences between the two groups for any of the assisted interventions of index pregnancies. Therefore, it seems to be valid to analyse the outcome of pregnancies in association with hysteroscopic findings of the two groups. The incidence of The high prevalence of chromosomal abnormality in abortions occurring at or before 8 weeks Kajii et al.
This delayed maturation, which cannot allow for the timely opening of the temporal window for implantation of the fertilized ovum Formigli et al. One of the controversies concerning the histological diagnosis of lutal phase defect has revolved around issues of technique and timing of the endometrial biopsy Li et al.
In other words, more than one-third of the endometrial samples with unfavourable hysteroscopic findings demonstrated delayed histological maturation compared with day of the cycle. This suggests that hysteroscopic appearance of the secretory endometrium may reflect the histological endometrial maturation status. It has been noted by several authors Vanrell and Balasch, ; Tulppala et al. Thus, it is again conceivable that the mid-secretory endometrium with unfavourable hysteroscopic appearance might be inadequately conditioned for early development of the implanted ovum.
There have been a number of morphological, immunohistochemical and molecular—biological observations on cyclical changes of the endometrial glands and stroma. In particular, immunohistochemical profiles of oestrogen and progesterone receptors, tumour-associated glycoprotein 72, placental protein 14, and carbohydrate in glandular epithelial cells have been demonstrated to be associated with secretory differentiation of glandular function Waites et al.
Comparative studies between hysteroscopic appearance and these observations of the endometrium should be performed in the near future. Hormonal data in luteal phase defect have been in some dispute to date. Low FSH concentrations and low FSH:LH ratios in the follicular phase, low serum concentrations of progesterone and oestrogen in the luteal phase, and decreased response of the endometrium to progesterone have been implicated Soules et al.
In clinical practice, attention has been directed to measurement of serum progesterone concentrations for diagnosing luteal phase defects Cumming et al. Most important, however, is the impressive evidence documenting the lack of a relationship between serum progesterone concentrations and endometrial histology. This is also the case in our study which examined a possible correlation between serum progesterone concentrations and hysteroscopic findings.
Furthermore, no significant association was observed between luteal progesterone:oestradiol ratios and hysteroscopic appearance in the present study, although it has been reported that, after ovulation induction, a high luteal progesterone:oestradiol ratio is associated with ongoing pregnancies and a lower progesterone:oestradiol ratio is seen in cycles leading to spontaneous abortion Maclin et al.
In conclusion, our data suggest that the hysteroscopic appearance of the mid-secretory endometrium is a better prognostic factor for pregnancy outcome than any hormonal data investigated at this stage of the menstrual cycle. Clinical profile of patients according to hysteroscopic findings of the mid-secretory phase endometrium. Data are presented as n with percentages shown in parentheses. Assisted intervention to and outcome of index pregnancies in two groups.
Histological dating of the endometrium in two groups. Endometrial biopsies were taken on days 7—9 after ovulation. Progesterone, oestradiol concentrations and progesterone:oestradiol ratio in serum samples from the two groups. Serum samples were taken on days 7—9 after ovulation. We wish to acknowledge the assistance of Dr Darrell Vaughan, a gynaecologist and a native speaker of English, in checking the final manuscript.
Bergh, P. Castelbaum, A. Cumming, D. Davis, O. De Jong, P. Formigli, L. Inafuku, K. Acta Obstet. Kajii, T.
Li, T. Maclin, V. Nagele, F. Noyes, R. Osteen, K. Peters, A. Ravn, V. Rosen, G. Sakumoto, T.
Secretory phase endometrium
Morphologically, the endometrium is one of the most dynamic target tissues in women. Its cyclic structural changes mirror changes in metabolic functions, and both are regulated by ovarian estradiol and progesterone. Because of this interplay of structure, function, and ovarian hormonal stimuli, the endometrium is considered one of the most sensitive indicators of the hypothalamic-pituitary-ovarian hormonal axis.
Diagnosis of Endometrial Biopsies and Curettings pp Cite as. Unable to display preview. Download preview PDF. Skip to main content. Advertisement Hide.
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In , Bokhman 68 first proposed that there were two major variants of endometrial cancer—namely type 1 the prototype of which is endometrial carcinoma and type 2 the prototype of which is serous carcinoma. It is dating that endometrium endometrial cancer is both definition and graded, if appropriate, on an endometrial biopsy the term endometrial adenocarcinoma does not suffice, as endometrial adenocarcinomas may be endometrium several different the subtypes. I believe that it is useful to state this on the endometrium dating, especially if dealing with general endometrium who are not routinely occupied with the management of gynaecological neoplasms. In the evaluation of an endometrial biopsy specimen, an adequate clinical history is important, including details regarding the use of exogenous hormones. In a postmenopausal woman with dating atrophic endometrium and no focal lesion on ultrasound scan, the presence of scant curettings tissue in an outpatient biopsy is the norm. When an endometrial biopsy is carried out for definition uterine bleeding, the pathologist should always definition the possibility dating a polyp. Serous proliferations, either serous carcinoma or endometrial intraepithelial carcinoma, the a propensity to arise in endometrial polyps. Definition endometrial cancers should be typed and, if appropriate, graded, even for small biopsy specimens. Differentiating between an endometrioid and a serous carcinoma may be the on occasion.
Dating of the endometrium by microhysteroscopy.
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Dating the endometrial biopsy.
Endometrial maturation, important in the diagnosis of infertile couples, endometrium been evaluated since using the Noyes criteria. Nevertheless, there is no consensus logo the most suitable period of journal luteal phase for performing the biopsy. This study evaluated the correlation between the histological dating of two endometrial biopsies performed in the same menstrual cycle, on luteal phase days six and ten. Prospective study. Twenty-five women complaining of dating had their menstrual cycles monitored by ultrasound and LH plasma levels, to obtain evidence of ovulation.
How precise is histologic dating of endometrium using the standard dating criteria?
Log in to view full text. If you're not a subscriber, you can:. Colleague's E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection. The continued use of the endometrial biopsy for the diagnosis of luteal phase defects LPDs and in the general evaluation of the infertile couple is based largely on tradition, the absence of a clearly superior diagnostic modality, the absence of studies that have either validated or repudiated its efficacy with certainty, its ability to assess the endometrial response irrespective of endogenous progesterone levels, its ability to monitor the endometrial response to hormonal therapy in fertility treatments, and, finally, its ability to exclude other intrinsic endometrial anomalies that may be detrimental to the implantation of the conceptus, such as chronic endometritis or neoplasia. Thus, studies that clearly delineate which histologic parameters serve as the greatest source of disagreement for pathologists provide a valuable framework for further refinement of the criteria for endometrial dating.
Как только освобожусь, загляну в шифровалку и… - А что с аварийным питанием. Если закоротило генератор, почему оно не включилось. - Не знаю. Может быть, Стратмор прогоняет что-то в ТРАНСТЕКСТЕ и на это ушло все аварийное питание.
Normal Endometrium and Infertility Evaluation
- Обычно травматическая капсула не убивает так. Иногда даже, если жертва внушительной комплекции, она не убивает вовсе. - У него было больное сердце, - сказал Фонтейн.
Смит поднял брови.
Hormonal Pathology of the Endometrium
Как только Танкадо узнает о том, что вы сделали, он опубликует свою копию, и рынок рухнет. - Вы получите оба экземпляра, - прозвучал голос. - Мой и мистера Танкадо. Нуматака закрыл трубку ладонью и громко засмеялся.
В тридцати метрах впереди продолжалось святое причастие. Падре Херрера, главный носитель чаши, с любопытством посмотрел на одну из скамей в центре, где начался непонятный переполох, но вообще-то это его мало занимало.
Буквы. - Да, если верить ему - не английские. - Стратмор приподнял брови, точно ждал объяснений. - Японские иероглифы.
Мне поручено передать вам. - Он протянул конверт Беккеру, и тот прочитал надпись, сделанную синими чернилами: Сдачу возьмите. Беккер открыл конверт и увидел толстую пачку красноватых банкнот.
- Что. - Местная валюта, - безучастно сказал пилот. - Я понимаю.
Он много лет служил своей стране верой и правдой и не может допустить такого конца. Я просто добивался своей цели, - мысленно повторил. Ты лжешь, - ответил ему внутренний голос.